At Samantha Slotnick OD, FAAO, FCOVD, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.
- Please download, print and fill out all needed forms (AdobeReader® required).
- Please contact Jane, our Patient Care Coordinator, to determine which forms you will need. Jane@DrSlotnick.com. 845-519-3521.
- You can return forms via fax (914-885-1463) or scan/email to Jane@DrSlotnick.com.
- Remember to bring originals with you to the first appointment.
New Patient Health History Form, Basic, Adult
New Patient Extended History Form – Children
New Patient Extended History Form – Adult
Quality of Life Questionnaire
Adults with Strabismus Questionnaire
Brain Injury Visual Symptom Survey
Directions via Public Transportation / train schedule / bus 20/21 schedule
Download & Review Form